City of Lowell Oregon

VOLUNTEER BOARD/COMMISSION APPLICATION
Contact Information
Name
Street Address
Mailing Address
City/State/Zip Code
Home Phone
Work/Cell Phone
Email Address
Background
Years of Residence in Lowell
Place of Employment
Occupation
Educational Background
Prior Civic Activities
Boards/Commissions of Interest
Please check all of the following Boards/Commissions that interest you.
....	City Council Budget Committee Planning Commission Parks Advisory Committee Other short term task groups that would meet for a specific purpose and then disband when the business is completed
Special Skills or Qualifications
Summarize any special training, skills or experience you may have pertinent to the Board/Commission to which you are applying.
....
Motivation
Discuss your motivation for serving on this Board/Commission.
....
Special Notice
Please be advised that members of the City Council and Planning Commission are required to file an annual STATEMENT OF ECONOMIC INTEREST with the State of Oregon. A sample reporting form is available on the Oregon Ethics Commission website www.oregon.gov indicating the type of information you will be required to disclose if you are appointed.
Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.
Name (printed)
Signature
Date
Our Policy
It is the policy of the City of Lowell to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability. The City of Lowell accepts applications from potential boards/commission members throughout the year and will hold applications until vacancies exist on specific boards/commissions.
Thank you for completing this application form and for your interest in volunteering with us.